Case Studies on the Cost of Medical Home Transformation and Maintenance in the Safety Net While there is a large and growing body of research developing on the patient-centered medical home (PCMH), few studies have assessed the cost of the PCMH from the perspective of the primary care providers that are expected to implement the model. Most research about PCMH cost has focused on system-level cost- savings through prevention of emergency department visits and hospitalizations; however, most primary care providers do not benefit financially from those savings. Further, while a small body of literature exists on the practice costs of the PCMH, we are not aware of any existing studies that address either the long-term maintenance cost to the practice or the comparative cost experience by practice type. During this 18-month award, we propose an expansion of our analysis of practice costs of PCMH transformation in the Safety Net Medical Home Initiative, a demonstration project comprised of 65 primary care practices in Colorado, Idaho, Massachusetts, Oregon, and Pennsylvania that are transforming to become PCMHs. The principal aims of this expansion of our study are to (1) assess the long-term maintenance costs of PCMH transformation and (2) assess differences in PCMH cost experience by type of practice. Our study aims will provide us with knowledge about PCMH practice costs, whether these costs increase, decrease or remain stable after practice facilitators complete their work, and whether the cost experience is different between urban and rural practices or large and small practices. The findings from this study should be relevant for primary care settings who are attempting to make informed decisions on adopting the PCMH model. We believe that each of the outcomes described in this proposal is a critical point of information that practices across the country will need to understand in order to make informed decisions to undergo PCMH transformation. Policymakers and researchers will also likely find our results useful as they address critical questions of how to incentivize PCMH transformation in a way that will result in lasting change. Our study of maintenance of PCMH transformation and costs can provide improved insight on the long-term return on investment for policies that fund PCMH transformation, while also pointing to specific areas to improve sustainability. Our comparative assessment of PCMH cost experience by setting can provide insight on whether some practice settings (e.g. rural or small practices) may require more support for PCMH transformation. The data collected from these case studies will help to paint an important picture of what the costs of medical home transformation are for a variety of practices over time.